Emergency room usage rate may reveal local doctor shortage

New London County residents, it seems, have a bad habit when it comes to seeking medical care.

The county's two emergency departments, at The William W. Backus Hospital in Norwich and Lawrence + Memorial Hospital in New London, have a combined usage rate that is higher than the statewide average, according to figures presented at a recent community forum.

"Emergency care is not a substitute for having a doctor of your own who keeps you well and costs you less," said Russell Melmed, epidemiologist at Ledge Light Health District who compiled the data.

His data shows that over a five-year period, there were 45,908 emergency department visits for every 100,000 New London County residents. That compares to the statewide rate of 36,410 visits for every 100,000 Connecticut residents. The data is for 2005 to 2009, the most recent available from the state Department of Public Health, but Melmed said he doesn't expect that more recent numbers would have affected his findings.

The data, he noted, reflects only patients treated and released from emergency rooms, not those admitted to the hospital from the ER because of more serious conditions. That indicates that many of the cases could have been treated by a primary care doctor.

"The most likely explanation is that people in New London County have an access to primary care issue," he said.

In fact, data compiled by the Robert Wood Johnson Foundation shows that there is one doctor for every 1,098 New London County residents, compared to a statewide average of one doctor for every 729 people.

Other factors could be long wait times for appointments and a lack of doctors who accept certain types of insurance including Medicaid, or other reasons, Melmed said. Further study would need to be done to pinpoint the causes.

He compiled and presented the data in January for the Community Health Needs Assessment by L+M. The higher rates of emergency care in New London County, he said, emerged from the study as one of the priority areas on which the region should focus in response to the assessment.

The higher rates for emergency care in New London County were seen across all categories of reasons people go to the hospital, from injuries and poisoning to respiratory diseases - including asthma - and diabetes-related flare-ups. Both of those chronic conditions, Melmed said, can be better controlled more economically at home, with regular primary care visits, versus in emergency rooms.

Recognizing that emergency department overuse is a problem, Backus has undertaken two major initiatives to address the problem of inappropriate use, spokesman Shawn Mawhiney said. He noted that Backus' recently opened satellite emergency department in Plainfield (in Windham County) is much busier than anticipated, on track to see 20,000 patients in its first year compared to the 11,500 that had been anticipated. A shortage of primary care doctors and a lack of health insurance due to unemployment are the likely causes, he added.

But the hospital is working to recruit primary care doctors to its service area, he said, and even with the doctor shortage, it is working to get patients into a system of regular medical care. Through its My Health Direct and Access to Care initiatives, Backus staff are redirecting patients who don't have regular doctors to primary care physicians at United Community & Family Services, Generations Family Health Center and four local physicians who have joined the program.

"We make an appointment for them on the spot," Mawhiney said. "The problem is that we can give people appointments, but we can't make them keep them."

Backus, he said, is now considering offering incentives such as store gift cards to get people to keep appointments.

At L+M, which provides emergency care at the main hospital in New London and the Pequot Health Center in Groton, an initiative called the Center for Innovation is considering how to improve quality and efficiency of health care. Figuring out how to reduce inappropriate emergency department usage is part of that, said Laurel Holmes, director of community health outreach and partnerships at L+M.

"Another contributing factor is that there are groups who are not familiar with using a primary care provider, who believe that the emergency room is where you go for health care," she said, adding that a public education campaign is being considered.

Holmes said groups formed in response to the findings of the health needs assessment also will be working to develop ways to address issues about primary care doctor shortages.

L+M spokesman Mike O'Farrell said other factors contributing to the higher rates of emergency care in New London County include a regional population that's older than the statewide average. Also, tourists drawn to the region's coastal communities and attractions make up a significant portion of emergency patients, particularly at Pequot.

"And it is easy to come to the ED," he added. "Some may see it as a disincentive to see a primary care provider - particularly short-term. The ED provides 24-7 care, all the testing you need and quicker answers. The belief is that everyone should have primary care, but if you don't, it's easy to understand why folks would come to the ED first."